RN exams clinical judgment practice questions, set 126
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 126
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Five clinical judgment questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A pregnant patient is at 32 weeks gestation and reports feeling fatigued and weak. What is the nurse's priority intervention?
A. Assess the patient's hemoglobin levels to check for anemia.
B. Encourage the patient to increase physical activity and exercise.
C. Instruct the patient to rest and avoid any strenuous activity.
D. Recommend a high-calorie diet to improve energy levels.
Show answer and rationale
Correct answer: A — Assess the patient's hemoglobin levels to check for anemia.
The correct answer is A: Assess the patient's hemoglobin levels to check for anemia.
1. During pregnancy, anemia is common due to increased blood volume and demands. Fatigue and weakness are common symptoms.
2. Anemia can lead to complications for both the mother and baby if left untreated.
3. Assessing hemoglobin levels will help determine if anemia is present and guide appropriate interventions.
4. Prompt treatment of anemia can improve symptoms and prevent adverse outcomes.
Summary:
B: Increasing physical activity may exacerbate fatigue if anemia is present.
C: Resting is important, but addressing the underlying cause of fatigue is crucial.
D: A high-calorie diet may not address the root cause of fatigue and could potentially worsen anemia if not properly managed.
Question 2
A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at all. What understanding will improve the nurse's planning? These patients are
A. members of cultural groups that have a different view of time.
B. immature and irresponsible in health care matters.
C. acting-out feelings of anger toward the system.
D. displaying passive-aggressive tendencies.
Show answer and rationale
Correct answer: A — members of cultural groups that have a different view of time.
The correct answer is A: members of cultural groups that have a different view of time. Hispanic American and Native American cultures may have different perceptions of punctuality and time management. Hispanic American cultures may prioritize relationships over strict adherence to schedules. Native American cultures may have a more fluid concept of time. It is important for the nurse to understand and respect these cultural differences to provide effective care.
Choices B, C, and D are incorrect because they make assumptions about the patients' behaviors based on stereotypes or psychological theories that are not relevant to the situation. It is crucial to avoid making unfounded judgments and instead focus on cultural competence when providing healthcare services.
Question 3
What is the role of the cervix during pregnancy?
A. Prevent infection and maintain pregnancy
B. Facilitate sperm entry
C. Support implantation of the fertilized egg
D. Produce estrogen
Show answer and rationale
Correct answer: A — Prevent infection and maintain pregnancy
The correct answer is A: Prevent infection and maintain pregnancy. The cervix acts as a physical barrier to prevent infections from reaching the uterus, protecting the developing fetus. It also produces mucus that blocks the entry of harmful microorganisms. Additionally, the cervix helps maintain the pregnancy by staying closed and firm until it's time for labor.
Choice B (Facilitate sperm entry) is incorrect because the cervix actually filters and allows only healthy sperm to pass through. Choice C (Support implantation of the fertilized egg) is incorrect because the cervix is not directly involved in the implantation process, which occurs in the uterus. Choice D (Produce estrogen) is incorrect because estrogen is primarily produced by the ovaries, not the cervix.
Question 4
A nursing assistant can respond to sundowning by
A. Adding more caffeine to the diet.
B. Setting a bedtime routine.
C. Restricting exercise during the day.
D. Scheduling activities during this time.
Show answer and rationale
Correct answer: B — Setting a bedtime routine.
The correct answer is B: Setting a bedtime routine. This is because establishing a consistent bedtime routine can help regulate the individual's sleep-wake cycle and reduce the symptoms of sundowning. By creating a calming environment and promoting relaxation before bedtime, the nursing assistant can help the individual transition to sleep more smoothly.
Other choices are incorrect because:
A: Adding more caffeine to the diet can exacerbate symptoms of sundowning by disrupting sleep patterns and increasing agitation.
C: Restricting exercise during the day can lead to restlessness and pent-up energy, potentially worsening sundowning symptoms.
D: Scheduling activities during this time may be overwhelming for the individual and can increase confusion and agitation.
Question 5
Which of the following decreases the resistance in the arteries leading to the sinuses of the penis?
A. Stimulation of the sympathetic nerves innervating the arteries
B. Nitric oxide
C. Inhibition of activity of the parasympathetic nerves leading to the arteries
D. All of the above
Show answer and rationale
Correct answer: B — Nitric oxide
The correct answer is B: Nitric oxide. Nitric oxide is a potent vasodilator that relaxes smooth muscle in the arterial walls, leading to decreased resistance in the arteries. This results in increased blood flow to the sinuses of the penis, contributing to erectile function.
A: Stimulation of the sympathetic nerves innervating the arteries would actually increase resistance by causing vasoconstriction.
C: Inhibition of activity of the parasympathetic nerves leading to the arteries would also increase resistance as parasympathetic stimulation typically leads to vasodilation.
Therefore, the correct answer is B as it directly causes vasodilation and decreases resistance in the arteries leading to the sinuses of the penis, which is essential for erectile function.
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Question 6
A patient in labor is requesting an epidural but has a history of a previous back surgery. What is the most important assessment before proceeding with the epidural?
A. History of spinal surgery or deformity
B. Fetal heart rate
C. Perform a vaginal exam to assess for fetal position
D. Administer Pitocin
Correct answer:
The correct answer is C: Perform a vaginal exam to assess for fetal position. This is important because the position of the fetus can affect the safety and efficacy of administering an epidural in a patient with a history of back surgery. If the fetus is in a breech position or in any other position that could complicate the epidural placement, alternative pain management options may need to be considered.
A: History of spinal surgery or deformity is important but assessing the fetal position takes precedence in this scenario.
B: Fetal heart rate monitoring is essential during labor but not the most important assessment before proceeding with the epidural in this case.
D: Administering Pitocin is unrelated to the assessment needed before proceeding with the epidural.
Which of the following people may commit intimate partner violence (IPV)?
A. An uncle
B. A neighbor
C. A friend
D. A spouse
Correct answer:
The correct answer is D, a spouse, because intimate partner violence (IPV) specifically refers to violence or abuse that occurs between current or former romantic partners. Spouses fall under this category.
A: An uncle - While family members can also be perpetrators of IPV, the question specifies intimate partner violence, which typically involves romantic relationships.
B: A neighbor - Unless the neighbor is also a current or former romantic partner, they do not fall under the definition of IPV.
C: A friend - Friends are not considered intimate partners, so their actions would not be classified as IPV.
In summary, the correct answer is D because IPV pertains to violence within romantic relationships, while the other choices do not fit this specific criteria.
When Mateo was born prematurely to Yvonne, a cocaine addict, what can his caregivers expect?
A. He will be very attentive to the environment
B. His cries will be abnormally shrill and piercing
C. He will overcome the harmful effects of drug exposure by age 3
D. His motor development will be especially rapid during the first year
Correct answer:
Mateo, being born prematurely to a cocaine-addicted mother, is at risk for several health issues. One common effect of prenatal drug exposure is a higher likelihood of sensory and regulatory problems, such as having abnormally shrill and piercing cries. This is a potential outcome that Mateo's caregivers can expect due to his circumstances. Choice A is incorrect as there is no direct correlation between being born prematurely to a cocaine-addicted mother and being very attentive to the environment. Choice C is incorrect as overcoming harmful effects of drug exposure by age 3 is overly optimistic and may not be the case for all children exposed to drugs prenatally. Choice D is incorrect as rapid motor development is not typically associated with prenatal drug exposure.
An adolescent asks a nurse conducting an assessment interview, 'Why should I tell you anything? You'll just tell my parents whatever you find out.' Which response by the nurse is appropriate?
A. That isn't true. What you tell us is private and held in strict confidence. Your parents have no right to know.'
B. Yes, your parents may find out what you say, but it is important that they know about your problems.'
C. What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team.'
D. It sounds as though you are not really ready to work on your problems and make changes.'
Correct answer:
The correct answer is C because it acknowledges the importance of confidentiality regarding the adolescent's feelings while also highlighting the necessity of reporting certain critical issues like suicidal thoughts to ensure the adolescent's safety. This response respects the adolescent's privacy while prioritizing their well-being.
Choice A is incorrect because it inaccurately states that everything is held in strict confidence, which may not be the case for issues like suicidal thoughts. Choice B is incorrect as it dismisses the adolescent's concerns about privacy and may deter them from being open during the assessment. Choice D is incorrect as it makes assumptions about the adolescent's readiness without addressing their specific concerns about confidentiality.
Which statement accurately describes the importance of birthing person position changes during the second stage of labor?
A. Position changes have an impact on fetal descent.
B. Position changes can lead to support person stress.
C. Fetal descent is solely determined by uterine contractions.
D. Maintaining a supine position is the safest option.
Correct answer:
The correct answer is A because position changes during the second stage of labor can indeed impact fetal descent. Different positions such as upright, squatting, or on hands and knees can help utilize gravity to aid in the descent of the baby through the birth canal. This can potentially speed up labor and reduce the risk of complications.
Explanation of why the other choices are incorrect:
B: Position changes are not intended to lead to support person stress, but rather to optimize the birthing process.
C: Fetal descent is influenced by a combination of factors, including uterine contractions and maternal positioning.
D: Maintaining a supine position is not always the safest option as it can compress blood vessels, potentially reducing blood flow to the baby.
A client with a history of herpes simplex virus (HSV-2) infection asks the nurse about future sexual activity. Which response is most appropriate?
A. If the infection has healed, you do not have to use a condom.
B. Refrain from all sexual activity.
C. Use a condom during sexual activity only if the infection becomes active again.
D. Inform all potential sexual partners about the infection, even if it is inactive.
Correct answer:
Correct Answer: D
Rationale:
1. Informing all potential sexual partners about the HSV-2 infection, even if inactive, is crucial to ensure transparency and promote informed decision-making.
2. HSV-2 can be transmitted even when symptoms are not present, so partners need to be aware of the risk.
3. This approach demonstrates respect for the partners' autonomy and enables them to make choices regarding their own health.
Summary:
A: Incorrect. Using a condom is important even when the infection is inactive to prevent transmission.
B: Incorrect. Refraining from all sexual activity may not be necessary if proper precautions are taken.
C: Incorrect. Using a condom only when the infection is active does not fully address the risk of transmission during asymptomatic periods.
To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what?
A. Report the planned use of dietary supplements to the physician.
B. Decrease the intake of fluids to prevent urinary retention.
C. Abstain from sexual activity for 2 weeks following the initiation of treatment.
D. Anticipate a temporary worsening of urinary retention before symptoms subside.
Correct answer:
Step 1: Finasteride is a medication that works by decreasing glandular cellular activity and reducing prostate size.
Step 2: Dietary supplements can interact with finasteride, potentially affecting its effectiveness or causing adverse effects.
Step 3: Reporting the planned use of dietary supplements to the physician ensures proper monitoring and adjustment of the treatment plan.
Step 4: This communication promotes patient safety and optimal therapeutic outcomes.
Therefore, choice A is correct as it emphasizes the importance of informing the physician about dietary supplement use to ensure the efficacy and safety of finasteride. Choices B, C, and D are incorrect as they do not directly relate to the mechanism of action or specific considerations of finasteride therapy.
Select the drug which tends to reverse insulin resistance by increasing cellular glucose transporters:
A. Glibenclamide
B. Rosiglitazone
C. Acarbose
D. Prednisolone
Correct answer:
The correct answer is B: Rosiglitazone. Rosiglitazone is a thiazolidinedione that works by activating peroxisome proliferator-activated receptor gamma (PPAR-gamma), which then increases the expression of glucose transporters on the cell membrane. This leads to improved cellular glucose uptake and utilization, thus reversing insulin resistance.
Rationale:
A. Glibenclamide is a sulfonylurea that stimulates insulin secretion from the pancreas but does not directly affect cellular glucose transporters.
C. Acarbose is an alpha-glucosidase inhibitor that delays carbohydrate digestion but does not increase cellular glucose transporters.
D. Prednisolone is a corticosteroid that can worsen insulin resistance by increasing blood glucose levels through various mechanisms.
A. Apply internal pressure to the abdomen by means of an inflated balloon to prevent bleeding.
B. Prevent abdominal distention.
C. Instill feedings into the stomach for the post-op patient.
D. Help in the elimination of urine.
Correct answer:
The correct answer is B: Prevent abdominal distention. A Salem Sump tube is a type of nasogastric tube used for decompression and drainage of the stomach. It helps prevent abdominal distention by removing air and fluids from the stomach. This is important in preventing complications such as vomiting, aspiration, and bowel obstructions.
Choice A is incorrect because the purpose of a Salem Sump tube is not to apply internal pressure to the abdomen to prevent bleeding.
Choice C is incorrect because a Salem Sump tube is not used to instill feedings into the stomach but rather to remove contents from the stomach.
Choice D is incorrect because a Salem Sump tube is not used to help in the elimination of urine; it is specifically designed for gastric decompression.
A two-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?
A. Determine the pulse deficit
B. Administer the scheduled dose
C. Calculate the safe dose range
D. Review the serum digoxin level
Correct answer:
The correct action for the nurse to take is to administer the scheduled dose of digoxin. A heart rate of 128 bpm in a two-year-old child with heart failure falls within the safe range for digoxin administration. It indicates that the child's heart rate is not excessively low, which could be a concern for administering digoxin. Therefore, proceeding with the scheduled dose is appropriate in this scenario. Determining the pulse deficit (Choice A) is not necessary in this situation as the heart rate is already obtained. Calculating the safe dose range (Choice C) is not required as the heart rate is within the safe range. Reviewing the serum digoxin level (Choice D) is not needed at this point since the heart rate indicates that administering the next dose is appropriate.
RN exams clinical judgment practice questions, set 126 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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